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Cervical epidural abscess mimicking as stroke - report of two cases.

Velpula JM, Gakhar H, Sigamoney K, Bommireddy R - Open Orthop J (2014)

Bottom Line: We would like to highlight two cases provisionally diagnosed as stroke.The delay in diagnosis and treatment led to suboptimal outcome in both cases.Cases with suspected stroke who deteriorate while under treatment or whose diagnosis is doubtful should have MRI whole spine in order to avoid potential complications.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Royal Derby Hospital, Derby, UK.

ABSTRACT

Background: Stroke is a common provisional diagnosis in patients presenting to the emergency department (ED) with unilateral neurological deficit. Cervical epidural abscess (CEA) may also present clinically with a unilateral neurological deficit.

Objects: To highlight the inherent problems with diagnosing cervical epidural abscess and possible consequences of delay in diagnosis.

Case report: We would like to highlight two cases provisionally diagnosed as stroke. Both cases turned out to be cervical epidural abscesses. The delay in diagnosis and treatment led to suboptimal outcome in both cases.

Summary: Cases with suspected stroke who deteriorate while under treatment or whose diagnosis is doubtful should have MRI whole spine in order to avoid potential complications.

No MeSH data available.


Related in: MedlinePlus

Case 2 Saggital T1W pre-op images showing epidural abscess and cord.
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Figure 4: Case 2 Saggital T1W pre-op images showing epidural abscess and cord.

Mentions: 74-year female presented to casualty for being unwell for 2 weeks. She also complained of right side arm and leg weakness. In the past she did suffer from chronic obstructive pulmonary disease. On physical examination she had MRC grade III power in her right upper limb myotomes and MRC grade IV power in her right lower limb myotomes. She also had some sensory dulling but that was non dermatomal. She was provisionally diagnosed to have a left middle cerebral artery territory stroke. Her vital signs were normal. Her leukocyte count was raised (13000/mm3) and urine dip showed nitrates and leucocytes. A CT scan of her brain was performed, which was normal. Over the next day her weakness progressed to all four limbs. Next day she underwent a carotid Doppler scan which revealed a large pre-vertebral swelling. Subsequent MRI scan of her spine showed C4/5 discitis with a cervical epidural abscess causing cord compression which was decompressed surgically the same day. (Fig. (3): Case 2 Saggital T2W and Fig. (4): T1W pre-op images showing epidural abscess and cord compression). She had anterior decompression and culture sensitive antibiotic treatment. She recovered partially to regain MRC 3+/5 motor power in her upper limbs. After one


Cervical epidural abscess mimicking as stroke - report of two cases.

Velpula JM, Gakhar H, Sigamoney K, Bommireddy R - Open Orthop J (2014)

Case 2 Saggital T1W pre-op images showing epidural abscess and cord.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3927375&req=5

Figure 4: Case 2 Saggital T1W pre-op images showing epidural abscess and cord.
Mentions: 74-year female presented to casualty for being unwell for 2 weeks. She also complained of right side arm and leg weakness. In the past she did suffer from chronic obstructive pulmonary disease. On physical examination she had MRC grade III power in her right upper limb myotomes and MRC grade IV power in her right lower limb myotomes. She also had some sensory dulling but that was non dermatomal. She was provisionally diagnosed to have a left middle cerebral artery territory stroke. Her vital signs were normal. Her leukocyte count was raised (13000/mm3) and urine dip showed nitrates and leucocytes. A CT scan of her brain was performed, which was normal. Over the next day her weakness progressed to all four limbs. Next day she underwent a carotid Doppler scan which revealed a large pre-vertebral swelling. Subsequent MRI scan of her spine showed C4/5 discitis with a cervical epidural abscess causing cord compression which was decompressed surgically the same day. (Fig. (3): Case 2 Saggital T2W and Fig. (4): T1W pre-op images showing epidural abscess and cord compression). She had anterior decompression and culture sensitive antibiotic treatment. She recovered partially to regain MRC 3+/5 motor power in her upper limbs. After one

Bottom Line: We would like to highlight two cases provisionally diagnosed as stroke.The delay in diagnosis and treatment led to suboptimal outcome in both cases.Cases with suspected stroke who deteriorate while under treatment or whose diagnosis is doubtful should have MRI whole spine in order to avoid potential complications.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Royal Derby Hospital, Derby, UK.

ABSTRACT

Background: Stroke is a common provisional diagnosis in patients presenting to the emergency department (ED) with unilateral neurological deficit. Cervical epidural abscess (CEA) may also present clinically with a unilateral neurological deficit.

Objects: To highlight the inherent problems with diagnosing cervical epidural abscess and possible consequences of delay in diagnosis.

Case report: We would like to highlight two cases provisionally diagnosed as stroke. Both cases turned out to be cervical epidural abscesses. The delay in diagnosis and treatment led to suboptimal outcome in both cases.

Summary: Cases with suspected stroke who deteriorate while under treatment or whose diagnosis is doubtful should have MRI whole spine in order to avoid potential complications.

No MeSH data available.


Related in: MedlinePlus